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Wiki UHC SNP Program Not Paying Medicaid Portion

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nikkianglin

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Opelika, AL
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We have a few patients with UHC SNP programs with this issue. UHC is processing the Medicare portion and leaving the copay/deductible to the patient and not paying the Medicaid portion. When submitted to Medicaid, they state that they have already paid UHC for contract services and that UHC is responsible and to bill their advantage plan. Also, that we can't bill the patient for the balance because they have Medicaid coverage. UHC says they are not responsible, that Medicaid is. It has been going in circles for months. We've tried getting the patients to call as well and no resolution. I don't know what other options we have. Any advice?
 
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The Medicaid portion won't pay if the primary (medicare) portion hits their (medicaids) allowable amount. In these instances, we adjust the remaining balance off as we can't bill the pt. The remaining balance is typically a fairly small amount in most cases, it's not a huge blow
 
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